The audit found that the Department of Health and Human Services (Department) omitted accuracy standards and changed payment methods from contingency to hourly for post-payment reviews, despite known problems with contract work. The Department did not evaluate the accuracy of post-payment reviews that the contractor performed of durable medical equipment claims, nor did the Department have a formal quality assurance process to evaluate the accuracy of the contractor's prepayment reviews. Finally, the audit found the Department excluded penalties for nonperformance from its Medicaid claims prepayment review contract.

Division/Office
Audit Reports
Performance Audits
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General Government
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